Multivitamins (renal)
Dialysis patients have very specific vitamin needs. It is important that these patients only take
multivitamins and supplements recommended by their health care team at the dialysis clinic. Many renal
multivitamins are available for people who are dialysis dependent, with or without a prescription. A higher
dose of folic acid (1.0 milligram [mg]/tablet or higher) usually are available by prescription only.
The renal multivitamin is primarily composed of water-soluble vitamins. Their composition usually
follows the recommendations of the National Kidney Foundation™. Some have fat-soluble vitamins and/or
minerals added, which usually is what distinguishes them.
End-stage renal disease
Patients with end-stage renal disease (ESRD) have larger vitamin needs for four different reasons:
 Meal plan: The dialysis patients’ meal plan is restricted in fruits, vegetables, and dairy products.
Therefore, their diet becomes deficient in many vitamins. Their frequent lack of appetite and poor food
intake also contributes to an insufficient intake of vitamins.
 Treatment: The dialysis treatment itself directly promotes the loss of vitamins from the body. The
treatment cleans the blood from extra fluid and toxins, as well as important vitamins.
 Other requirements: People with ESRD also require more protection from heart disease, access
problems, inflammation, and anemia, which increases their vitamin needs.
 Uremic state: The body uses vitamins differently for individuals who are in a uremic state.
Water-soluble vitamins
Water-soluble vitamins do not accumulate in the body, making replacement necessary because they are
lost through treatment. Folic acid, B6, and B12 are known to decrease the risk of heart disease by
decreasing homocysteine levels. Homocysteine is an amino acid produced by the breakdown of protein.
Its high level in the dialysis population is known to lead to heart disease.
Fat-soluble vitamins
Fat-soluble vitamins are not removed by the dialysis treatment and can easily accumulate to toxic levels, if
supplemented in excess. Vitamin A usually is not added because of its toxicity. Vitamin D usually is given
as the active form by prescription. Serum levels of parathyroid hormone (PTH), phosphorus, and calcium
will help determine the appropriate dosage. Some renal multivitamins now include vitamin D in the form
of cholecalciferol or D3. Vitamin E, an antioxidant, is offered in some multivitamins, but supplementation
usually is not needed. Vitamin K is not added because of its known effect on blood clotting.
Peritoneal dialysis
The vitamin and mineral recommendations for peritoneal dialysis patients are similar to those of patients
on hemodialysis. The water-soluble vitamins are lost to the peritoneal dialysate, and replacement is
required. Vitamin D is prescribed based on the serum levels of calcium, phosphorus, and PTH in the same
fashion as hemodialysis patients, but it is taken orally.
The different renal multivitamins
Choosing a renal multivitamin sometimes is difficult and confusing. You should discuss which brand of
renal vitamins to take with your physician. The brand you choose is a personal preference, as long as it
meets your doctor’s requirements. Different insurance plans also cover different multivitamins, and many
generics are now available. A variety of supplements are available under several different brand names,
including but not limited to Dialyvite®, Nephro-Vite®, Nephrocaps®, and Renaltab®.
The following vitamin chart compares some of the main renal multivitamins and their contents.
Vitamin Comparisons (renal)
(this list is not all-inclusive)
Name/
Manufacturer
Folic
Acid
Thiamine
(B1)
Riboflavin
(B2)
Niacin
(B3)
Pyridoxine
(B6)
Vit
B12
Pantothenic
Acid
Biotin
Vit
C
Vit
E
Zinc
Selenium
Iron
Dialyvite®
5000, Rx
5 mg
1.5 mg
1.7 mg
20 mg
50 mg
2 mg
10 mg
300
mcg
100
mg
30
IU
25
mg
70 mcg
-
Dialyvite®
3000, Rx
3 mg
1.5 mg
1.7 mg
20 mg
25 mg
1 mg
10 mg
300
mcg
100
mg
30
IU
15
mg
70 mcg
-
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
100
mg
-
-
-
-
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
100
mg
-
50
mg
-
-
Dialyvite®
800, OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
-
Dialyvite® 800
Zn, OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
50
mg
-
-
Dialyvite® 800
Zn15, OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
15
mg
-
-
Dialyvite® 800
Fe, OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
29
mg*
Nephro-Vite®,
Rx
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
-
Nephro-Vite®,
OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
-
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
5 mg
150
mcg
100
mg
-
-
-
-
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
12.5
mg
-
-
NephPlex®,
Rx
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
-
RenaPlex®,
OTC
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
15
mg
-
-
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
40
mg
-
-
-
200
mg†
Renaltab® I,
OTC
1 mg
12.5 mg
7.5 mg
50 mg
20 mg
12.5
mcg
30 mg
300
mcg
125
mg
-
15
mg
-
-
Renaltab® II,
OTC
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
-
Hillestad
Dialyvite®, Rx
Dialyvite® Zn,
Rx
Watson
Valeant
Nephrocaps®,
Rx
Nephro-Tech
Vital-D Rx®
Nephron FA®,
Rx*
Renalabs
Renaltab® Zn,
OTC
1 mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
15
mg
-
-
1 mg
1.5 mg
0.7 mg
20 mg
10 mg
10 mg
10 mg
300
mcg
60
mg
-
-
-
-
0.9
mg
1.5 mg
0.7 mg
20 mg
10 mg
10 mg
10 mg
300
mcg
60
mg
-
-
-
-
0.8
mg
1.5 mg
1.7 mg
20 mg
10 mg
6 mcg
10 mg
300
mcg
60
mg
-
-
-
Llorens
Nephronex
Caps®, Rx
Nephronex
Liquid®, OTC
Cypress
Rena-Vite,
OTC
-
mcg=microgram, mg=milligram
*Elemental iron
†Ferrous fumarate
Contact information for renal vitamins
Cypress Pharmaceuticals, Inc
www.cypressrx.com
800-856-4393
Valeant Pharmaceutical International, Inc
http://www.valeant.com/prescription-brands.aspx
866-246-8245
Hillestad Pharmaceuticals
www.dialyvite.net
866-358-9773
Llorens Pharmaceuticals
http://www.llorenspharm.com/
866-595-5598
Nephro-Tech, Inc
http://www.nephrotech.com/
800-879-4755
Renalab
www.renalabs.com
800-345-3838
Watson Pharmaceuticals™
www.watson.com
800-272-5525
References and recommended readings
Kidney Disease Outcomes Quality Initiative. NKF KDOQI Guidelines: KDOQI Clinical Practice Guidelines
for Bone Metabolism and Disease in Chronic Kidney Disease. Available at:
http://www.kidney.org/professionals/kdoqi/guidelines_bone/guide7.htm. Accessed December 7, 2012.
National Kidney Foundation. Vitamins and minerals in kidney disease. Available at:
http://www.kidney.org/atoz/content/vitamineral.cfm. Accessed December 7, 2012.
Review Date 12/12
R-0588